What is a milk bleb?
A milk bleb appears as a white or yellow dot on the nipple. It is from a blockage of the nipple pore by either thickened milk or a layer of skin that has formed over the nipple pore creating a blockage. If milk is completely obstructed from flowing from that site, it can feel painful. If you try to express milk from where the bleb is by putting pressure around the area, it may slightly bulge as the milk behind the skin is pushed forward but can’t escape. Blebs are an inflammatory response and can be on just one nipple or both. The epithelial cells react and form a fibrous layer at the site of the nipple pore and block milk from spraying.(1)
What causes a bleb?
- Oversupply - When someone makes more milk than their baby needs, they are more vulnerable to plugged ducts and milk blebs. Unremoved milk can clog the ducts and milk pores at the end of the ducts creating a bleb. People with oversupply may have recurring blebs due to inflammation.
- Plugged ducts - If you find there is a hard pea-sized lump on your breast, it may be from milk that has built up and is creating a clog in the duct. Milk is not able to pass freely through the duct and is stuck. Plugged ducts can be present with milk blebs, but are not always.
- Positioning & latch - how a baby is positioned at the breast/chest can help them or make it harder for them to latch on deeply to breast tissue. If they have a shallow latch, the nipple may become damaged from the friction of the nipple rubbing on the roof of their mouth. Milk may not be able to be removed as effectively and you are at higher risk for a bleb to form.
- Oral function - Once your baby is latched, they use their lips to form a seal at the breast/chest as the tongue extends out over the bottom gum line and cups the areolar tissue. The baby sucks a large portion of areolar tissue and the nipple in their mouth and begins to use their jaw, face, and tongue muscles to move milk further back in the ducts towards the nipple with a positive pressure of the tongue pressing the breast/chest into the roof of the mouth. The nipple should be as far back as to where the hard and soft palate meet. Here, the nipple is pressed into the softer tissue of the soft palate rather than the harder front section of the roof of the baby’s mouth. As the baby lowers its tongue and jaw, a vacuum occurs and milk sprays out of the nipple pores for the baby to drink. Milk blebs can form when the baby is using their tongue differently, compensating for not being able to move their tongue in its full range of motion or ineffectively removing milk.
- Pressure - If you wear tight clothing, a bra that is constructive, or sleep on your front for too long, it may contribute to plugged ducts, milk blebs, and the nipple pain from them.
Milk bleb imposters
- Thrush - Several white spots on the nipple that is more flat rather than raised may be a sign that you are dealing with thrush. Typically a bleb is a single raised area. Other symptoms of thrush are a shiny red appearance or flaking of the skin on the areola. It can be itchy and some people experience sharp pain with thrush. Your baby may also have white patches in their mouth along the roof of their mouth and on the sides of their cheeks. Reach out to your IBCLC for how to manage and resolve thrush and help identify what the root cause is.
- Blister - A blister is caused by friction. It may look like the size of a bleb and be on the nipple like a bleb, but is usually dark red caused by blood, not by stuck milk.
How to get rid of a milk bleb
- Soften the blister - Gently apply coconut or olive oil on the bleb and a warm, moist washcloth over top to soften the bleb. You can gently rub the bleb with the cloth to see if you can remove the layer of skin that has formed over top. Apply NipDip to keep the skin soft in between feeding, pumping, and applying the oil and warm washcloth, to promote healing of the skin and reduce pain from the bleb. After the bleb opens, NipDip can help the skin heal and help avoid recurrence.
- Epsom salt - fill a container with 1 cup of warm water and 2 teaspoons of Epsom salt. Submerge the area with the bleb in the saline mixture for 10-15 minutes and repeat 4 times a day.
- Change breastfeeding position - If pressure or trauma to your nipple is the cause of the bleb, try changing your baby’s position for feeding along with trying to help your baby latch more deeply when nursing.
Nursing after a saline soak or applying oil and moist heat can help release the bleb by the baby suck.
- Colloidal silver - after the bleb is opened, keep the area clean and free of pathogens. Some people use colloidal silver as part of a protocol for reducing inflammation when dealing with mastitis. Blebs and clogged ducts that are not resolved can turn into mastitis.
- Zinc - is necessary for immune function and wound repair, zinc helps support healthy skin and heal damaged skin.(3)
- Potato poultice - potatoes grated or sliced and placed over the bleb may help draw out the inflammation and make it easier to release the milk that has backed up.
- Silica cell salt - cell salts help the body absorb and utilize minerals. Silica is great for hair, skin, and nails helping to keep the skin elastic and collagen healthy.(2) Silica helps cleanse and clear the skin of unwanted or non-functional matter like the skin covering of a bleb.
- See the doctor - while some people use a sterile needle at home to gently detach the layer of skin on the nipple, it is recommended to go to the doctor to unroof the bleb.
How to avoid reoccurrence
- Diet - Reduce saturated fat in your diet. Add foods high in zinc for healthy skin and skin integrity. Some zinc-rich foods include oysters, pumpkin seeds, cashews, walnuts, chia seeds, oats, lentils, beans, and chickpeas.(4)(5) As a bonus, these foods support a healthy milk supply.
- Latch and oral function assessment - an IBCLC who has taken continuing education in the area of oral function will have the skill sets needed for properly checking your baby’s ability to latch and feeding skills. Not all IBCLCs are the same so you will need to ask about their experience. They will be able to guide you through improving positioning, latch, and feeding, giving exercises, and appropriate referrals if needed.
- Flange size assessment - if your flange Does not fit properly, it can cause nipple trauma or put pressure on the ducts causing clogs and blebs. A flange that is too small or too large may be uncomfortable and inhibit milk removal. Proper flange size should draw only the nipple into the flange tunnel, be comfortable and get plenty of sprays of milk out. If you are not sure about your correct flange size, talk with your IBCLC or set up a comprehensive flange consultation with one of Legendairy Milk’s IBCLCs.
- Sunflower lecithin - lecithin helps combine the water and fat molecules helping milk flow through the ducts without getting stuck to the sides of the ducts or clogging the ducts and nipple pores.
Take a probiotic - LactaBiotic contains a strain of probiotics called Lactobacillus fermentum. It offers protection by promoting breast health and a healthy immune system.
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